The Clincal Characteristics Of Drug-induced Autoimmune Hepatitis

Objective:Discuss the clinical characteristics of drug-induced liver injury（DILI）and drug-induced autoimmune hepatitis（DIAIH）patients,so as to obtain the law of the disease,understand the disease,and improve the diagnostic ability of the disease.Methods:A retrospective analysis was performed on patients with DILI who were hospitalized in Shengjing Hospital of China Medical University from January 2013 to October 2020.Gender,age,detailed medication history,laboratory examination and pathological results were collected.DILI was diagnosed in strict accordance with the 2015Guidelines for Diagnosis and Treatment of Drug-induced Liver Injury in China.Patients with RUCAM score≥6 were diagnosed as DILI.Patients with DILI showed positive autoantibodies after discontinuation of medication.Combined with comprehensive evaluation of pathological results,the diagnosis was considered as DIAIH and classified as the DIAIH group,while the other patients were classified as simple DILI,non-DIAIH group.The clinical characteristics of DIAIH were obtained by using SPSS25.0 software and statistical methods.Results:A total of 960 patients with simple DILI and 61 patients with DIAIH were included in this study.There were 602 female patients（62.71%）and 358 male patients（37.29%）in the non-DIAIH group.There were 55 female patients（90.16%）and 6 male patients（9.84%）in the DIAIH group.Patients in the non-DIAIH group were 1-85 years old,with an average of 49.45±16.46 years old,and the most common patients were 46-60 years old（391 cases,40.73%）.Patients in the DIAIH group were aged 37-63 years,with an average age of 52.90±11.82 years.See more women in both groups patients,but statistically significant difference in gender composition（x²）=18.846,P<0.001).All DILI group of patients had the exact medical history,all pathogenic drug comparison between the two groups,differences statistically significant(^x2=15.309,P=0.044<0.05),two comparison found:health care products and other drugs and antibiotics group differences statistically significant（P<0.05）,health care products and other medicines and Chinese herbal medicine group differences statistically significant（P<0.05）.In terms of clinical symptoms,both groups mainly had dark urine color,fatigue and anorexia,except fatigue and anorexia,there was no significant difference between two groups（P>0.05）.Two groups of patients with liver cell damage model,including non-DIAIH group（59.06%）,DIAIH group（47.54%）,there was also no statistically significant difference between two groups of patients in liver injury types（x²）=4.023,P=0.242>0.05).Simple DILI and DIAIH autoantibodies in patients with positive rate was 19.79%（190/960）and 100%,respectively,of which the ANA positive rate was 16.25%（156/960）patients with the former,the ANA positive rate of the later was 86.89%（53/61）,statistically significant differences（x²）=175.779,P<0.001).Of 960 patients with simple DILI,only 97 cases（10.10%）to improve the liver pathology examination,61 cases of DIAIH patients,47 patients（77.05%）,improve the liver pathology inspection,found that patients with simple DILI and DIAIH group has the following histopathological characteristics:hepatocyte steatosis,eosinophils,with or without bridging necrosis and cholestasis,collect abbacy inflammatory cell aggregation lesions.Interfacial inflammation and lymphatic-plasma cell infiltration were more obvious in DIAIH group.Conclusions:Patients with simple DILI and DIAIH were mainly middle-aged and elderly women,and the main inducing drugs were Chinese herbal medicine.Fatigue,deepened urine color and anorexia were the most common clinical manifestations in both groups,and a few patients had no symptoms.Most patients with DIAIH showed positive ANA.Interfacial hepatitis and portal lymphatic-plasma cell infiltration were more specific for the diagnosis of DIAIH.The prognosis of most patients is good,early diagnosis,withdrawal of relevant drugs,combined with glucocorticoid therapy can reduce the occurrence of liver failure.